gonçalves: mozambique

7/28/2019 Gonalves: Mozambique

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REPBLICA DE MOAMBIQUEMINISTRIO DA SADE

Facility based newborn care:Country successes and challenges

Mozambique

Dra. Bernardina GonalvesPediatrician

GLOBAL NEWBORN HEALTH CONFERENCEApril 15-18, 2013Johannesburg, SA


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National Health Servicesat glance

1387 Health Facilities 7 Provincial Hospitals and 3 Central Hospitals 1292 Health Facilities with Maternities- 24

hours/day 1033 provide ANC/PMTCT/FP/PNC- 8 hours/day Density of midwives, nurses and doctors per

1,000 population: 0.3 Health Facilities/habitants: 1/10.000 hab


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Type of HF

Frequency #deliveries

Intra hospitalNM Rate

/1000 Livebirths

CentralHospitals

1.261 21.983 57.4

ProvincialHospitals

639 23.617 27

GeneralHospitals

20 23.219 0.86

RuralHospitals

350 47.668 7.34

HealthCenters

214 195.664 1.09

Total 2.484 312.151 7.96

The main causesof Death werePrematurity

(50%),Severe asphyxia

(32%),

Neonatal sepsis( 29%)

Mortality & Causes of Deaths

Source: Maternal & newborn health needs assessment,2009


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Causes of Newborn Deaths

Source: National Survey : Causes of Mortality, INE 2007

Neonatal Sepsisconstitute the main causeof death amongNewborns born in RuralHealth Centres (27.3%)

and at community level(44.9%)

This demonstrated aneed to improve ouractions and interventionsat these levels to betteraddress the NB sepsismore efficiently


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Intervention Packages Type of HF Type of ServiceProvider

M a t e r n a l

Focused 4-visit antenatal package (tetanusimmunization, detection & management of syphilis, other infections, pre-eclampsia,Malaria intermittent presumptive therapy,folic acid, PMTCT, Counseling and healtheducation)

District, Provincial, GeneralRural Hospitals and Urban,Rural Health Centers ,andOutreach services

MCH nurses, Preventivemedicine agents andtechnicians forvaccination

Doctors (High risk ANC)

Emergency obstetric care /ENCAntibiotics for preterm rupture of membranes

1/500.000 hab (Emoc Basic;5/500.000 hab (Emoc Complete)

MCH nurses, surgicaltechnicians, Doctors

Corticosteroids for PT Central, Provincial, Generaland Rural Hospitals(specialized)

Gynecology& Obstetricspecialists

Family Planning Central, Provincial, GeneralRural Hospitals and Urban,Rural Health Centers andOutreach services

MCH nurses, curativemedicine agents&technicians, Doctors

Model Maternity /Quality performance based standards (2009 & 2011)

Central, District, Provincial,General Rural Hospitals andUrban Health Centers, HealthCenters with maternities

MCH nurses,technicians,Doctors, surgicaltechnicians

Newborn Health Interventions


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Intervention Packages Type of HF Type of Service Provider

N e w

b o r n

Essential Newborn Care / Neonatal Resuscitation(ventilation & cardiac massage)/Management of moderated and Severe Newborn Illness

Central, District, Provincial,General Rural Hospitals

MCH Nurses, pediatric nurses,Generalists, Gynecology& Obstetricspecialists

Essential Newborn Care/ and Helping Babies Breathe(2011)

Urban and Rural Health Centers Elementary/basic midwives, MCHNurses

Integrated Management of Childhood Illness -Neonatal component (2008)- including treatment for

infections with ATB & PMTCT

District, Provincial, General RuralHospitals and Urban, Rural

Health Centers and Health Posts *

MCH Nurses, pediatric nurses,Curative Medicine Agents &

Technicians , Generalists

Kangaroo Mother Care (2009) Central, District, Provincial,General Rural Hospitals andUrban, Rural Health Centers

MCH Nurses, pediatric nurses,Curative Medicine Agents &Technicians , Generalists, specializedDoctors

Post-natal care with focus on the 1st week of life (visiton day 3, 7) and between day 21-28 to support

health practices and earlier detection and referral of complications

District, Provincial, General RuralHospitals and Urban, Rural

Health Centers and outreachservices

MCH Nurses, pediatric Nurses,

Model Maternity (2009) Neonatal component(immediate skin-skin contact, early breastfeeding early - first hour after birth , neonatal resuscitation and PosNatal Care - 3, 7 and 21-28 days after deliver)

Central, District, Provincial, GeneralRural Hospitals and Urban HealthCenters, Health Centers type I and A

MCH Nurses, pediatric Nurses,Generalists, Gynecology& Obstetricspecialists, Curative Medicine Agents &Technicians , Generalists, Managers

Quality performance base standards (2011)

Newborn Health Interventions


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COVERAGE OF SPECIFIC INTERVENTIONS

Number of health facilitieswith Emergency Obstetric

&Newborn Care:

530 out of 1.292 HF

More than 1.000 healthworkers have been trained

in ENC from 2009 to2010

IMNCI :Since 1998 the package

has been scaled up to 144Districts with support from

country collaborationpartners.

In 2008 the strategy wasupdated to add Neonatal

Care and HIV/AIDS.

Implementation of anaction plan for effectiveroll out

will start in May 2013

KMC:The method have been

introduced to all Provinces.In most HF it is an integrated

service( no specific units)

KMC is integrated as keythematic issue in most

continuing education MNCHtrainings.

HBB : Recently adopted by theCountry.

330 Health Workers and 43National master trainers havebeen trained , an action plan to

accelerated the roll out of HBB iscurrently being prepared .

The coverage of the interventions within the provinces is variable depending onlocal partners support..The country still need to improve M&E system to monitorimplementation of these interventions as well as certification of the HF thatimplement it. Preliminary data from national quality assessment of newbornservices done in 2012 is still to be finalized.


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P e r c e n

t a g

e

Quality Standards Areas

Data from 28 Health Facilities

uccesses:Improving Quality with Performance

based Standards

Inclusion of NB Quality Standards indicators in the HIS


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Data from 28 Health Facilities

Comparison between the Baseline (2009-10) and theLast Measurement (Q4 2011 or later)

Inclusion of NB Quality Standards indicators in the HIS


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Training of health professionals in the area of Maternal & newbornhealth, targeting all District Staff(not only specific HF staff toovercome the issue of high turn over)

Inclusion of the package interventions in pre service trainingcurriculum ( HBB in discussion for inclusion)

Inclusion of materials & equipment as an essential item in existingmaterial & equipment Kits(Penguin, Bag & Mask, essential drugsfor NB resuscitation, ATB( IM/IV) for Sepsis/infections, EmOC kits)

Emerging Maternal and Newborn audit committees based on clearoperational guidelines Community Health Communities & Co-management Committees

operational Guidelines to promote effective Community-HF

linkages

Successes :Working towards Sustainability


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Challenges

Insufficient availability of human resources/Weak institutionalcapacity for retention of qualified human resources

Implementation of an action plan to accelerate roll out of IMNCI,HBB and KMC( training and mentoring of HW, supplies,certification criteria and Inclusion of specific indicators for thoseinterventions at HIS/routine data management )

Improve the health infrastructure to the newborn (to reduce

overcrowding services neonatology to prevent sepsis)


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Improve the availability of ATB (parenteral) to treatsepsis and other commodities/material andequipment at all levels

Upgrading of existing Health Post

Update IMNCI training curricula for

Revision of training curricula, role & responsibilities of

TBAs, APEs and other Community Health Volunteers

Challenges


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gonçalves: mozambique

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